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Charitakis E, Metelli S, Karlsson LO, Antoniadis AP, Rizas KD, Liuba I, Almroth H, Hassel Jönsson A, Schwieler J, Tsartsalis D, Sideris S, Dragioti E, Fragakis N, Chaimani A. Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: a network meta-analysis. BMC Med 2022; 20:193. [PMID: 35637488 PMCID: PMC9153169 DOI: 10.1186/s12916-022-02385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is no consensus on the most efficient catheter ablation (CA) strategy for patients with atrial fibrillation (AF). The objective of this study was to compare the efficacy and safety of different CA strategies for AF ablation through network meta-analysis (NMA). METHODS A systematic search of PubMed, Web of Science, and CENTRAL was performed up to October 5th, 2020. Randomized controlled trials (RCT) comparing different CA approaches were included. Efficacy was defined as arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of 6 months. RESULTS In total, 67 RCTs (n = 9871) comparing 19 different CA strategies were included. The risk of recurrence was significantly decreased compared to pulmonary vein isolation (PVI) alone for PVI with renal denervation (RR: 0.60, CI: 0.38-0.94), PVI with ganglia-plexi ablation (RR: 0.62, CI: 0.41-0.94), PVI with additional ablation lines (RR: 0.8, CI: 0.68-0.95) and PVI in combination with bi-atrial modification (RR: 0.32, CI: 0.11-0.88). Strategies including PVI appeared superior to non-PVI strategies such as electrogram-based approaches. No significant differences in safety were observed. CONCLUSIONS This NMA showed that PVI in combination with additional CA strategies, such as autonomic modulation and additional lines, seem to increase the efficacy of PVI alone. These strategies can be considered in treating patients with AF, since, additionally, no differences in safety were observed. This study provides decision-makers with comprehensive and comparative evidence about the efficacy and safety of different CA strategies. SYSTEMATIC REVIEW REGISTRATION PROSPERO registry number: CRD42020169494 .
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Affiliation(s)
- Emmanouil Charitakis
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Silvia Metelli
- Research Center of Epidemiology and Statistics (CRESS-U1153), Université Paris Cité, INSERM, Paris, France
| | - Lars O Karlsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Antonios P Antoniadis
- 3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Konstantinos D Rizas
- Medizinische Klinik Und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ioan Liuba
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Almroth
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Hassel Jönsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jonas Schwieler
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Skevos Sideris
- Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Elena Dragioti
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nikolaos Fragakis
- 3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Anna Chaimani
- Research Center of Epidemiology and Statistics (CRESS-U1153), Université Paris Cité, INSERM, Paris, France
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Charitakis E, Metelli S, Karlsson LO, Antoniadis AP, Liuba I, Almroth H, Hassel Jönsson A, Schwieler J, Sideris S, Tsartsalis D, Dragioti E, Fragakis N, Chaimani A. Comparing Efficacy and Safety in Catheter Ablation Strategies for Paroxysmal Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials. Diagnostics (Basel) 2022; 12:diagnostics12020433. [PMID: 35204535 PMCID: PMC8870912 DOI: 10.3390/diagnostics12020433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/14/2022] [Accepted: 01/29/2022] [Indexed: 11/16/2022] Open
Abstract
Although catheter ablation (CA) is an established treatment for paroxysmal atrial fibrillation (PAF), there is no consensus regarding the most efficient CA strategy. The objective of this network meta-analysis (NMA) was to compare the efficacy and safety of different CA strategies for PAF. A systematic search was performed in PubMed, Web of Science, and CENTRAL until the final search date, 5 October 2020. Randomised controlled trials (RCT) comparing different CA strategies and methods for pulmonary vein isolation (PVI) were included. Efficacy was defined as lack of arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of six months. In total, 43 RCTs comparing 11 different CA strategies involving 6701 patients were included. The risk of recurrence was significantly decreased in comparison with PVI with radiofrequency only for the following treatments: PVI with adjuvant ablation (RR: 0.79, CI: 0.65–0.97) and PVI with sympathetic modulation (RR: 0.64, CI: 0.46–0.88). However, PVI with radiofrequency was superior to non-PVI strategies (RR: 1.65, CI: 1.2–2.26). No statistically significant difference was found in safety between different CA strategies. Concerning different PVI strategies, no difference was observed either in efficacy or in safety between tested strategies. This NMA suggests that different PVI strategies are generally similar in terms of efficacy, while PVI with additional ablation or sympathetic modulation may be more effective than PVI alone. This study provides decision-makers with insights into the efficacy and safety of different CA strategies.
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Affiliation(s)
- Emmanouil Charitakis
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
- Correspondence:
| | - Silvia Metelli
- Research Center of Epidemiology and Statistics (CRESS-U1153), INSERM, Université de Paris, 75004 Paris, France; (S.M.); (A.C.)
| | - Lars O. Karlsson
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
| | - Antonios P. Antoniadis
- 3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School, 54124 Thessaloniki, Greece; (A.P.A.); (N.F.)
| | - Ioan Liuba
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
| | - Henrik Almroth
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
| | - Anders Hassel Jönsson
- Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden; (L.O.K.); (I.L.); (H.A.); (A.H.J.)
| | - Jonas Schwieler
- Heart and Vascular Theme, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Skevos Sideris
- Department of Cardiology, Hippokration Hospital, 11527 Athens, Greece;
| | - Dimitrios Tsartsalis
- Department of Clinical Physiology, Linköping University Hospital, 581 85 Linköping, Sweden;
| | - Elena Dragioti
- Pain and Rehabilitation Centre, Linköping University Hospital, 581 85 Linköping, Sweden;
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Nikolaos Fragakis
- 3rd Cardiology Department, Hippokrateion General Hospital, Aristotle University Medical School, 54124 Thessaloniki, Greece; (A.P.A.); (N.F.)
| | - Anna Chaimani
- Research Center of Epidemiology and Statistics (CRESS-U1153), INSERM, Université de Paris, 75004 Paris, France; (S.M.); (A.C.)
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